Surgical Management and Risk Factors of Postoperative Respiratory Dysfunction of Cavernous Malformations Involving the Medulla Oblongata.

ABSTRACT

OBJECTIVE: To evaluate surgical management of cavernous malformations (CMs) involving the medulla oblongata and to predict risk factors of postoperative respiratory dysfunction (RDF). METHODS: Patient data from individuals who underwent surgical treatment for CMs involving the medulla oblongata were retrospectively reviewed. Patients with postoperative RDF and/or deficits of the cough reflex (CR, ≥7 days) were deemed as having bad respiratory statuses. A binary logistic regression analysis tested the association of preoperative predictors with bad postoperative respiratory status. RESULTS: The study consisted of 69 patients. Preoperatively, 9 patients (13.0%) had dyspnea, and 4 (5.8%) had hypoxemia. Postoperatively, 11 patients (15.9%) had bad respiratory statuses, including RDF as a respiratory rhythm disorder and/or dyspnea in 6 patients, and ≥7 days of CR deficits in 5 patients. With a mean follow-up duration of 35.3 months, the neurologic status improved in 45 patients (68.2%), remained unchanged in 11 (16.7%), and worsened in 10 (15.1%) relative to the preoperative baseline. A multivariate logistic regression analysis identified that the independent adverse factors of bad postoperative respiratory status were multiple preoperative hemorrhages, large lesion size, and surgical intervention during the chronic period (>8 weeks). CONCLUSIONS: Postoperative RDF and CR deficits could commonly occur in patients with CMs involving the medulla oblongata. However, patients with fewer preoperative hemorrhages, small lesion size, and operation within 8 weeks of the last bleeding are prone to be associated with a reduced possibility of bad postoperative respiratory status.